Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation.

ABSTRACT: BACKGROUND: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. METHODS: An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. RESULTS: Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. CONCLUSION: The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty

Mortality, violence and access to care in two districts of Port-au-Prince, Haiti

ABSTRACT: BACKGROUND: Towards the end of 2006 open conflict broke out between United Nations forces and armed militia in Port-au-Prince, Haiti. Fighting was most intense in the district of Cité Soleil. METHODS: A cross-sectional, random-sample survey among the conflict-affected populations living in Cité Soleil and Martissant was carried out over a 4-week period in 2006 using a semi-structured questionnaire to assess exposure to violence and access to health care. Household heads from 945 households (corresponding to 4,763 people) in Cité Soleil and 1,800 household (9,539 people) in Martissant provided information on household members. The average recall period was 579 days for Cité Soleil and 601 days for Martissant. RESULTS: In Cité Soleil 120 deaths (21 children) were reported (CMR 0.4 deaths/10,000 people/day; <5 MR 0.5 deaths/10,000/day) while in Martissant 165 deaths (8 children) were reported (CMR 0.3/10,000 people/day; <5 MR 0.2/10,000 people/day). Violence was reported as the main cause of adult mortality in both locations (mainly gunshot wounds) accounting for 29.2% of deaths in Cité Soleil and 23% of deaths in Martissant. 22.9% of families in Cité Soleil and 18.6% in Martissant reported at least one victim of violence. Destruction of property and belongings was common in both Cité Soleil (52.4% of families) and Martissant (14.9%). Access to health services was limited, with 11% (22/196) of victims of violence in Cité Soleil and 23% (49/212) in Martissant unable to access care due to insecurity or lack of money. DISCUSSION: Extrapolating to the total population of these two districts some 2,000 violent deaths occurred over the recall period. Among the survivors, violence had lasting effects in terms of physical and mental health and loss of property and possessions

Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali.

Malaria is the most common cause of morbidity and mortality in children under 5 in Mali. Health centres provide primary care, including malaria treatment, under a system of cost recovery. In 2005, Médecins sans Frontieres (MSF) started supporting health centres in Kangaba with the provision of rapid malaria diagnostic tests and artemisinin-based combination therapy. Initially MSF subsidized malaria tests and drugs to reduce the overall cost for patients. In a second phase, MSF abolished fees for all children under 5 irrespective of their illness and for pregnant women with fever. This second phase was associated with a trebling of both primary health care utilization and malaria treatment coverage for these groups. MSF's experience in Mali suggests that removing user fees for vulnerable groups significantly improves utilization and coverage of essential health services, including for malaria interventions. This effect is far more marked than simply subsidizing or providing malaria drugs and diagnostic tests free of charge. Following the free care strategy, utilization of services increased significantly and under-5 mortality was reduced. Fee removal also allowed for more efficient use of existing resources, reducing average cost per patient treated. These results are particularly relevant for the context of Mali and other countries with ambitious malaria treatment coverage objectives, in accordance with the United Nations Millennium Development Goals. This article questions the effectiveness of the current national policy, and the effectiveness of reducing the cost of drugs only (i.e. partial subsidies) or providing malaria tests and drugs free for under-5s, without abolishing other related fees. National and international budgets, in particular those that target health systems strengthening, could be used to complement existing subsidies and be directed towards effective abolition of user fees. This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid

An Integrated Approach for Dynamic Charging of Electric Vehicles by Wireless Power Transfer - Lessons Learned from Real-Life Implementation

The aim of this paper is to introduce a complete fast dynamic inductive charging infrastructure from the back-office system (EV management system) up to the Electric Vehicle (EV) (inductive power transfer module, positioning mechanism, electric vehicle modifications) and the EV user (User interface). Moreover, in order to assess the impact of the additional demand of inductive charging on the grid operation, an estimation of the 24-hour power profile of dynamic inductive charging is presented considering, apart from the road traffic, the probability of the need for fast charging, as well as the specifications of the proposed solution. In addition, an energy management system is presented enabling the management of the operation of the inductive charging infrastructure, the interaction with the EV users and the provision of demand response services to different stakeholders. The proposed dynamic inductive charging approach has been demonstrated within a real urban environment in order to provide useful insights regarding the experience gained from a real-field trial. The relevant practical conclusions are also discussed in this paper. Finally, a cost/benefit analysis, according to the Discounted Cash Flow (DCF) principles, is performed in order to assess the economic viability of the proposed solution.This work was supported by the European Commission within the 7th Framework Programme, Project FastInCharge under the Grant Agreement: 31428

The CORDEX.be initiative as a foundation for climate services in Belgium

The CORDEX.be project created the foundations for Belgian climate services by producing high-resolution Belgian climate information that (a) incorporates the expertise of the different Belgian climate modeling groups and that (b) is consistent with the outcomes of the international CORDEX ("COordinated Regional Climate Downscaling Experiment") project. The key practical tasks for the project were the coordination of activities among different Belgian climate groups, fostering the links to specific international initiatives and the creation of a stakeholder dialogue. Scientifically, the CORDEX.be project contributed to the EURO-CORDEX project, created a small ensemble of High-Resolution (H-Res) future projections over Belgium at convection-permitting resolutions and coupled these to seven Local Impact Models. Several impact studies have been carried out. The project also addressed some aspects of climate change uncertainties. The interactions and feedback from the stakeholder dialogue led to different practical applications at the Belgian national level

Assessing the importance and expression of the 6-year geomagnetic oscillation

The first time derivative of residual length-of-day observations is known to contain a distinctive 6 year periodic oscillation. Here we theorize that through the flow accelerations at the top of the core the same periodicity should arise in the geomagnetic secular acceleration. We use the secular acceleration of the CHAOS-3 and CM4 geomagnetic field models to recover frequency spectra through both a traditional Fourier analysis and an empirical mode decomposition. We identify the 6 year periodic signal in the geomagnetic secular acceleration and characterize its spatial behavior. This signal seems to be closely related to recent geomagnetic jerks. We also identify a 2.5 year periodic signal in CHAOS-3 with unknown origin. This signal is strictly axially dipolar and is absent from other magnetic or geodetic time series